Non-Alcoholic Fatty Liver Disease and NASH
Fatty Infiltration of the Liver and Steatohepatitis
Aug 11, 2009
Non-Alcoholic Fatty Liver Disease (NAFLD - steatosis) is a condition in which an abnormally high number of cells in the liver become infiltrated with fat. Non-Alcoholic Steatohepatitis (NASH) is a more serious version of the condition, in which inflammation and possible liver damage develops in addition to fatty infiltration. While most cases of NAFLD do not develop into the more serious NASH stage of the disease, it is important for those who are diagnosed, to be monitored regularly for any signs of significant disease-progression. Even when NASH does develop, it does not lead to liver damage in most cases but increases the importance in the condition being monitoring by a qualified physician.
NAFLD and NASH Symptoms and Blood Lab Results
Most patients do not experience symptoms with NAFLD and the condition is often found incidentally when blood tests are run and the condition shows up on liver function tests. The liver enzymes that are included on liver-panel lab tests include the ALT (alanine aminotransferase) and the AST (glutamic-oxaloacetic transaminase), both of which can detect liver damage from very mild to severe, depending on how highly elevated above normal values they become. Typical cases of NAFLD, present with mild to moderate elevations of these liver enzymes while NASH will often present with very high elevations. NASH patients are also observed for the presence of any physical symptoms that might indicate serious liver disease, such as jaundice (yellowing of the skin and/or eyes), dark colored urine and pain or swelling on the right side of the abdomen, just below the ribcage.
Confirming with Liver Ultrasound
Once abnormal liver enzyme counts are discovered and/or any physical symptoms of possible liver problems, a treating doctor will often refer the patient to a radiology lab technician to have a liver ultrasound performed. This test uses highly sensitive sound waves to transmit an image on a monitoring screen, to look for any abnormal textures, stones or lesions (damage) in the liver. The test also detects fatty infiltration of the liver, which will cause the organ to appear glossy in texture on the surface, which is referred to as an abnormal echogenicity. This type finding helps to confirm blood test results that point to NAFLD.
Liver Biopsy
If liver ultrasound does not reveal lesions, stones or damaged areas on the liver, no further testing is usually done. If however, the liver appears to have these type problems or other findings such as tumorous growths, an additional test, taking a tissue sample of the liver to be further analyzed might also be ordered. This is usually done using a hypodermic needle that is of the correct length, to insert into the liver from the surface of the skin while a patient is under anesthesia. A biopsy can detect malignancy (cancer cells), as well as irreversible liver damage which is referred to as cirrhosis (scarring).
Treatment for NAFLD and NASH
Patients diagnosed with NAFLD, will be given the recommendation to lose any excess weight and to modify their diets to reduce fatty foods and refined sugars, which can also convert into fat cells. Unhealthy fats that can cause problems including fatty liver and elevated cholesterol are called trans-fats and include hydrogenated and partially hydrogenated oils found in fried foods and simple carbohydrates (junk foods). Increasing intake of foods with fiber is also a common recommendation because it helps to clear the body and liver of excess stored fats. Healthy foods that help rid the body of unhealthy fats include fruits, vegetables, nuts and grains. Even though NAFLD is not caused by alcohol consumption, patients are also advised not to drink alcohol due to its potential damaging effect on the liver. Regular exercise to a patient’s tolerance level may also be recommended due to its many benefits including burning fat cells into energy. If a patient has co-existing diabetes, insulin resistance or thyroid disease, keeping these other metabolic-related disorders well-treated can also help.
NASH patients will be given the same diet and lifestyle recommendations but may also be treated with additional drug therapies such as insulin-sensitizing agents and other drugs typically used to treat diabetes. Medical research continues in attempting to find effective drugs and supplements (including studies of vitamin E) for treating NASH.
Fatty Liver: Nonalcoholic Fatty Liver Disease (NAFLD) information
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